Accessing gynecologic oncology care: A comparison of rural and urban gynecologic cancer patients

2022 ◽  
Vol 164 (1) ◽  
pp. 26-27
Author(s):  
Hannah McLaughlin ◽  
Katherine Harris ◽  
Alison Goldsmith ◽  
Amanda Allshouse
Keyword(s):  
Cancer Patients ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Rural And Urban ◽  
Oncology Care

Rate and Risk Factors for Surgical Site Infection in Gynecologic Oncology Surgeries at a Tertiary Care Facility in a Developing Country

2017 ◽  
Vol 5 (1) ◽  
pp. 23-27
Author(s):  
Erum S Khan ◽  
Sheikh Irfan ◽  
Natasha Khalid
Keyword(s):  
Risk Factors ◽  
Endometrial Cancer ◽  
Cancer Patients ◽  
Developing Country ◽  
Gynecologic Oncology ◽  
Tertiary Care ◽  
Gynecologic Cancer ◽  
Care Facility ◽  
Site Infection ◽  
Tertiary Care Facility

ABSTRACT Introduction Surgical site infections (SSIs) are among the most common complications in surgical patients and have serious consequences for outcomes and costs. There is a dearth of information on risk factors for developing SSI in patients undergoing gynecologic cancer surgery, and this has not been studied using national data. Objectives The objectives of this study were to estimate the prevalence, preoperative and operative risk factors associated with the higher risk of SSIs in gynecologic cancer patients undergoing surgery in a tertiary care facility in a developing country. Setting Department of Obstetrics and Gynaecology, Aga Khan University Hospitals, Karachi, Sindh, Pakistan. Materials and methods Retrospective record review of gynecologic oncology patients admitted for surgery from January 2015 to December 2015 was performed. Results A total of 100 patients met the inclusion criteria. Of these, 15 were identified with SSIs, which were all found to be of the superficial type. Approximately, 44, 40, and 7% were diagnosed with endometrial, ovarian, and cervical cancers respectively. The mean time from surgery to developing SSI was 12.9 days. Among endometrial cancer, 22.7% (10/44) had SSI compared with 7.5% (3/40) for ovarian cancer and 14.2% (1/7) for cervical cancer. The significant predictors of SSI were body mass index ≥35 (p-value <0.004), endometrial cancer diagnosis, the American Society of Anesthesiologists class more than 3, modified surgical complexity scoring system 3 to 4, and blood sugar levels more than 180 mg/dL within 48 hours after surgery in known diabetics. Conclusion About 15% of patients undergoing laparotomy for gynecologic malignancy developed SSIs. In this study, we identified several risk factors for developing SSI among gynecologic cancer patients. These findings may contribute toward identification of patients at risk for SSIs, and the development of strategies to reduce SSI rate and potentially reduce the cost of care in gynecologic cancer surgery. How to cite this article Khan ES, Irfan S, Khalid N. Rate and Risk Factors for Surgical Site Infection in Gynecologic Oncology Surgeries at a Tertiary Care Facility in a Developing Country. J South Asian Feder Menopause Soc 2017;5(1):23-27.

The impact of expanding gynecologic oncology care to ovarian cancer patients in small cities and rural communities

2021 ◽  
Author(s):  
Emma Jane Swayze ◽  
Lauren Strzyzewski ◽  
Pooja Avula ◽  
Aaron L. Zebolsky ◽  
Anna V. Hoekstra
Keyword(s):  
Ovarian Cancer ◽  
Rural Communities ◽  
Cancer Patients ◽  
Gynecologic Oncology ◽  
Small Cities ◽  
Oncology Care ◽  
The Impact

scholarly journals Road Map to Setting Up a Palliative Care Service in a Tertiary Center Gynecologic Oncology Unit in Egypt

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 176s-176s ◽  
Author(s):  
A. Abdelbadee ◽  
H. Abou-Taleb ◽  
A. Abbas ◽  
S. Ali ◽  
N. Fakie ◽  
...  
Keyword(s):  
Palliative Care ◽  
Developing Countries ◽  
Medical Students ◽  
Cancer Patients ◽  
Multidisciplinary Team ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Physical Symptoms ◽  
University Hospitals ◽  
Oncology Unit

Background and context: Developing countries struggle with high cancer mortality and low resources. Cancer patients experience pain and physical symptoms in addition to psychological, social and spiritual worries that increase as the patients' conditions progress. Palliative care (PC) primary goal is to help people live as well as they can for the duration of their illness, with the finest physical and emotional well-being possible despite complex problems. However, there are considerable barriers to PC service implementation in developing countries. Aim: Our goal is to set up a PC service and integrate it as a standard of care for gynecologic cancer patients managed at Assiut University Hospitals, Egypt. The objective of this study is to investigate the tools needed to integrate a PC service in any oncology service in developing countries. Strategy/Tactics: A capacity building and local provision PC development framework was laid. Strategies included expanding the gynecologic oncology unit, assessment of PC knowledge among health providers and medical students, assembling a multidisciplinary PC team, overseas PC training, establishing international links, providing essential medicine and addressing PC education. Program/Policy process: The gynecologic oncology unit capacity was expanded to accommodate long term admissions. PC knowledge among physicians, clinical nurse practitioners (CNPs) and medical students in Assiut University Hospitals was assessed using the modified Palliative Care Knowledge Test (PCKT). A multidisciplinary team that will deliver the PC service to our gynecologic cancer patients was assembled based on motivation and individual expertise in the aspects of PC from relevant departments as clinical oncology, surgery, pain and anesthesiology, psychiatry, physical therapy and rehabilitation and nutrition. The hospital leadership worked with the pharmacists to increase opioids quota and facilitate dispensing measures. The PC team leader engaged in a certified online PC course and arranged overseas training with the reputable Palliative Medicine Division at University of Cape Town well known for its legacy in delivering PC education. Outcomes: Ninety two physicians, 14 CNPs and 116 medical students completed the PCKT. The PCKT was composed of 20 questions and each correct answer was given 1 point. The overall total correct score was 7.41 ± 2.48 (Fig 1). Poor knowledge about PC was a strong indicator to acknowledge the gap in PC postgraduate training and undergraduate education. What was learned: Integration of a PC service for cancer patients in Egypt is feasible in spite of local resources constraints. A PC multidisciplinary team can be assembled from skilled specialists. Modifications of undergraduate and postgraduate curricula to include PC is crucial. Our model can be transferred to other low resource settings. [Figure: see text]

Surgical Universal euGlycemic Attainment during Recovery (SUGAR) Initiative.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 252-252
Author(s):  
Jolyn Sharpe Taylor ◽  
Katherine Cain ◽  
Terri Earles ◽  
Melinda Harris ◽  
Deepthi James ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Hemoglobin A1c ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Diabetic Patients ◽  
Cancer Type ◽  
Care Providers ◽  
Post Intervention ◽  
Operative Care ◽  
Operative Complications

252 Background: Surgical site infections (SSI) are infections of the surgical incision or organ space within 30 days of surgery and are associated with increased morbidity, mortality and healthcare expenditures. Diabetic patients undergoing laparotomy are at high risk. Prior studies have shown SSI reduction by avoiding hyperglycemia. The aim of our Quality Improvement (QI) initiative is to reduce the SSI rate among diabetic patients undergoing laparotomy by 40% within 2 years compared to the baseline (2/2015-8/2017) rate of 16%. Methods: We formed a multi-disciplinary QI team including physicians, nurses and advanced care providers from Gynecologic Oncology, Pharmacy, Nutrition, Endocrinology, Internal Medicine and Anesthesiology. The intervention began 2/2018 in our main center and 5 satellite sites including: screening gynecologic cancer patients undergoing laparotomy with hemoglobin A1C, intra-operative glucose monitoring with goal of < 180mg/dL, creation and use of a standardized basal-bolus insulin order set for post-operative care, and endocrine and nutritional consultation. The following variables were assessed: age, race, ethnicity, BMI, cancer type, comorbidities, smoking status, surgical procedure, receipt of antibiotic prophylaxis, hemoglobin A1C, post-operative glucose values, intervention compliance, intra-operative complications, post-operative complications including SSI, hospital readmissions, reoperation and mortality. Results: Since 2/2018, 39 gynecologic cancer patients have undergone laparotomy. Overall compliance with HgA1c screening is 64% (25/39), which has improved from 42% in 2/2018 to 70% in 3/2018 and 83% in 4/2018. Causes of non-compliance included unplanned conversion to laparotomy and need for additional education. Five of 39 (13%) patients were diabetic, including one newly diagnosed through this initiative. The post-intervention diabetic SSI rate is 0% (0/5) with all post-intervention glucose values < 180mg/dL. There have been no safety adverse events resulting in patient harm. Conclusions: Implementing a QI initiative to standardize management of diabetic patients undergoing surgery is both safe and feasible. Effectiveness data will continue to be collected.

Clinical and financial outcomes in cancer patients with integration of specialty palliative care versus standard oncology care.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 47-47
Author(s):  
Sam Gaster ◽  
Francine Arneson ◽  
Luis Alexander Rojas-Espaillat ◽  
Nathan Hruby ◽  
Mari Perrenoud
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Gynecologic Oncology ◽  
Cost Of Care ◽  
Care Utilization ◽  
Financial Outcomes ◽  
Palliative Care Consultation ◽  
Oncology Care ◽  
Care Consultation

47 Background: Evidence suggests that integrating palliative care into usual oncology care benefits patients with advanced cancer and their caregivers (Ferrell et al., 2017). We evaluated patients with an advanced cancer diagnosis with concurrent palliative care versus standard oncology care to determine how both clinical and financial outcomes differ in our cancer center. Methods: We conducted a retrospective analysis on 340 deceased cancer patients who attended an office visit at a medical/gynecologic oncology clinic between January 2018 and February 2019. Patients who received concurrent palliative care as well as patients that received usual oncologic care were included. Data available in the electronic health record (EHR) were abstracted to quantify patient and practice level data. We compared differences in advance care planning (ACP) documentation, DNR designation, hospice enrollment prior to death, chemotherapy in the last 14 days of life, and health care utilization and cost. Results: Forty-nine patients received a specialty palliative care consultation concurrent with their cancer care. Compared to their counterparts, patients who received a specialty palliative care consultation were more likely to have a completed advanced care plan (57% v 16%, p < .05), have a DNR designation (29% v 4%, p < .05) in the EHR, to enroll in hospice prior to death (78% v 50%, p < .05), and at an earlier time (Mdiff = 14 days, p = .05). Patients who received a specialty palliative care consultation were also less likely to receive chemotherapy in the last 14 days of life (2% v 7%) and end-of-life acute care utilization was lower in patients with a specialty palliative care consultation, including ED visits (50% v 67%) and hospitalizations (20% v 59%), but these results were not statistically significant. Median per patient per month (PPPM) total cost of care was higher pre-consult ($9,307) versus post-consult ($6,088; Diff = -$3,219), but this result was statistically non-significant. Conclusions: These results provide additional support for advantage of concurrent specialty palliative care in patients with advanced cancer versus standard oncologic care.

Evaluating the effect of a group pre-treatment chemotherapy psycho-education session for chemotherapy-naive gynecologic cancer patients and their caregivers

2021 ◽  
Vol 160 (1) ◽  
pp. 234-243
Author(s):  
Diana Samoil ◽  
Nazek Abdelmutti ◽  
Lisa Ould Gallagher ◽  
Nazlin Jivraj ◽  
Naa Kwarley Quartey ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Gynecologic Cancer ◽  
Education Session ◽  
Pre Treatment

Truth-Telling to Terminal Stage Cancer Patients in India: A Study of the General Denial to Disclosure

2021 ◽  
pp. 003022282110327
Author(s):  
Souvik Mondal
Keyword(s):  
Cancer Patients ◽  
Urban Areas ◽  
Family Members ◽  
Public Hospitals ◽  
Truth Telling ◽  
Full Disclosure ◽  
Terminal Stage ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Private And Public

Telling the truth to the terminal-stage cancer patients differs socio-culturally based on the priorities assigned to patients’ autonomy and the principles of beneficence and non-maleficence. After conducting in-depth interviews with 108 terminal-stage adult cancer patients, 306 family members, and 25 physicians, in private and public hospitals in both rural and urban areas, in the state of West Bengal, India it has been found that even though 85.60% of the patients prefer full disclosure, only 22.03% are actually informed. Though demographic characteristics, like age, gender, education etc., have marginal influences over the pattern of truth-telling, the main factor behind non-disclosure is the family members’ preference for principles of beneficence and non-maleficence over patient autonomy. Hence, only 9.32% of those 118 patients’ family members have agreed to full disclosure. Physicians comply with this culture of non-disclosure as family, in India, is the centre of decision-making and acts as the primary unit of care.

scholarly journals Survival in endometrial cancer in relation to minimally invasive surgery or open surgery – a Swedish Gynecologic Cancer Group (SweGCG) study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christer Borgfeldt ◽  
Erik Holmberg ◽  
Janusz Marcickiewicz ◽  
Karin Stålberg ◽  
Bengt Tholander ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Endometrial Cancer ◽  
Minimally Invasive ◽  
Cancer Patients ◽  
Surgical Approach ◽  
Open Surgery ◽  
Gynecologic Cancer ◽  
Multivariable Analysis ◽  
Figo Stage

Abstract Background The aim of this study was to analyze overall survival in endometrial cancer patients’ FIGO stages I-III in relation to surgical approach; minimally invasive (MIS) or open surgery (laparotomy). Methods A population-based retrospective study of 7275 endometrial cancer patients included in the Swedish Quality Registry for Gynecologic Cancer diagnosed from 2010 to 2018. Cox proportional hazard models were used in univariable and multivariable survival analyses. Results In univariable analysis open surgery was associated with worse overall survival compared with MIS hazard ratio, HR, 1.39 (95% CI 1.18–1.63) while in the multivariable analysis, surgical approach (MIS vs open surgery) was not associated with overall survival after adjustment for known risk factors (HR 1.12, 95% CI 0.95–1.32). Higher FIGO stage, non-endometrioid histology, non-diploid tumors, lymphovascular space invasion and increasing age were independent risk factors for overall survival. Conclusion The minimal invasive or open surgical approach did not show any impact on survival for patients with endometrial cancer stages I-III when known prognostic risk factors were included in the multivariable analyses.

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